Mobilization of the phrenic nerve in the thoracic cavity by video-assisted thoracic surgery

Abstract

Background: The use of video-assisted thoracic surgery (VATS) techniques to mobilize the phrenic nerve in the thoracic cavity for neurotization after brachial plexus injury was studied. Methods: From August 1999 to January 2000, 10 men and 1 woman with brachial plexus injury (left side in 5 and right side in 6) joined the study group. Their ages ranged from 20 to 38 years (average, 28 years). Supine after general anesthesia, all the patients had double-lumen trachea cannulas to guarantee complete lung collapse on the operative side. Three port incisions were made to allow introduction of the following: a 10-mm Stryker endoscope through the sixth intercostal space 2 cm medial to the anterior axillary line, one instrument for manipulation in the anterior axillary line of the third intercostal space, and another in the second intercostal space about 2 cm lateral to the parasternal line. The nerve was mobilized with two common long Mixter clamps and some endoscopic instruments by blunt and sharp dissection. Results: All patients were managed successfully without severe complications. The mean additional length of phrenic nerves by this technique was 16 cm. Conclusions: Mobilization of the phrenic nerve by VATS is a safe and minimally invasive method for elongating the nerve for neurotization after brachial plexus injury.